title: A systematic review of antibiotic utilization in China.
abstract: OBJECTIVE
  Reliable data about antibiotic utilization in the large pharmaceutical market of the world's most populous country, the People's Republic of China, are in short supply. Although many primary studies have investigated the use of antibiotics in China, most of the relevant studies were published in the Chinese language. This systematic review aims to summarize reported percentages of outpatient encounters resulting in the prescription of antibiotics in China.
  
  
  METHODS
  We systematically searched and reviewed studies of antibiotic prescribing patterns in China, published in Chinese or English between 2000 and August 2012. The study quality was assessed and the overall percentage of outpatient encounters resulting in the prescription of antibiotics was calculated using random-effects meta-analysis. Subgroup analyses were conducted to investigate heterogeneity across studies.
  
  
  RESULTS
  We included 57 eligible studies (with a total of 556 ,435 outpatient encounters). The overall percentage of outpatients prescribed antibiotics was 50.3% (95% CI: 47.4%-53.1%). Of the outpatients prescribed antibiotics, 74.0% (95% CI: 71.3%-76.6%) were prescribed one antibiotic, 23.3% (95% CI: 21.1%-25.7%) were prescribed two antibiotics and 2.0% (95% CI: 1.3%-2.8%) were prescribed three or more antibiotics. The proportion of antibiotic utilization differed greatly across hospital levels and geographical regions and fluctuated over time.
  
  
  CONCLUSIONS
  The percentage use of antibiotics is high in China. The excessive use of antibiotics is particularly more problematic in lower-level hospitals and in less developed western China. The implementation and impact of the national efforts to control the excessive use of antibiotics should be appropriately evaluated.
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P. R. China.
authors.forename: Xiaoxv
authors.initials: X
authors.lastname: Yin
authors.forename: Fujian
authors.initials: F
authors.lastname: Song
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Gong
authors.forename: Xiaochen
authors.initials: X
authors.lastname: Tu
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Wang
authors.forename: Shiyi
authors.initials: S
authors.lastname: Cao
authors.forename: Junan
authors.initials: J
authors.lastname: Liu
authors.forename: Zuxun
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002681:China; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic prescription; pharmacoepidemiology; usage